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To estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective during the early phases of the pandemic. Systematic review. Two parallel searches of academic bibliographic databases and grey literature were undertaken until 8 May 2020. Governments were also contacted for further information where possible. There were no restrictions on language, information sources used, publication status and types of sources of evidence. The AACODS checklist or the National Institutes of Health study quality assessment tools were used to appraise each source of evidence. Publication characteristics, country-specific data points, COVID-19-specific data, demographics of affected HCWs and public health measures employed. A total of 152 888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%, n=14 058) and nurses (38.6%, n=10 706), but deaths were mainly in men (70.8%, n=550) and doctors (51.4%, n=525). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.2 deaths reported per 100 infections for HCWs aged over 70 years. Europe had the highest absolute numbers of reported infections (119 628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7). COVID-19 infections and deaths among HCWs follow that of the general population around the world. The reasons for gender and specialty differences require further exploration, as do the low rates reported in Africa and India. Although physicians working in certain specialities may be considered high risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs.

Prominent ears (PEs) are the most frequent congenital external ear deformity, occurring in ∼5% of the population. Although the deformity does not usually cause functional difficulties, it can significantly affect the patient's psychological and social health. The authors aim to present the Welsh experience of pinnaplasty, reviewing our outcomes and complications. A retrospective cross-sectional study was performed of all patients undergoing pinnaplasty in Morriston Hospital, Swansea, Wales. We represent the tertiary plastic surgery referral unit across Wales. We included all patients undergoing pinnaplasty between 2015 and 2022 inclusive. We excluded patients undergoing revision procedures or those who had no follow-up. Over the 7-year period, 236 pinnaplasties were performed and 203 were included in the analysis. Ninety-six percent of cases were performed using a cartilage-sparing approach, which represents the mainstay in our unit. The mean follow-up length for our cases was 12 months. Revision procedures were required in 4% of cases. Three hematomas (1.5%) and one (0.5%) wound dehiscence due to infection were recorded and required a return to the operating room. Suture extrusion was noted in 5% of cases (10 patients); 4.5% (9) cases were affected by either hypertrophic or keloid scarring. Across the United Kingdom, cosmetic procedures have come under scrutiny, namely, because of a difficult economic climate. In the era of tight fiscal control in health care, it is pertinent to analyze the outcomes and performance metrics of our operations regularly, thus aiding in the development of an established evidence base to advocate for our respective patients. [ABSTRACT FROM AUTHOR]

In this report, we present an injury to the hand caused by an exploding vaping device. This report summarizes the burn, blast and chemical injury, and discusses best practice for treatment. This case provides a warning to healthcare professionals and the public about the potential for and the seriousness of this injury. We hope to emphasize the rising incidence of vaping among children, the injuries that may occur, and the methods for treatment. [ABSTRACT FROM AUTHOR]

Background: The psychological wellbeing and stresses on medical students are currently under a global spotlight. Under a wider initiative supported by the British Medical Association (BMA), international surveys have been conducted to understand and begin to tackle these issues. Method: This study aimed at describing the mental wellbeing and levels of burnout of Iranian medical students. A total of 179 medical students from 19 different cities participated voluntarily in the survey by answering an online questionnaire between April and August 2020. We detected a trend toward higher prevalence of psychiatric disorders (namely depressive disorders) and substance misuse when compared to previous national studies. Results: About 6% of students screened positive for alcohol problems with the CAGE questionnaire. About 77% of medical students screened positive for mental health problems with the GHQ12 questionnaire. Very high rates of burnout were also reported. These findings emphasize the urgent need to define methods to screen at risk medical students and implement local and national initiatives to curtain their potential detrimental effects. [ABSTRACT FROM AUTHOR]

The proven beneficial effects of low-load blood flow restriction training on strength gain has led to further exploration into its application during rehabilitation, where the traditional use of heavy loads may not be feasible. With current evidence showing that low-load blood flow restriction training may be less well tolerated than heavy-load resistance training, this review was conducted to decipher whether intermittently deflating the pressure cuff during rest intervals of a training session improves tolerance to exercise, without compromising strength. Four databases were searched for randomized controlled trials that compared the effect of intermittent versus continuous blood flow restriction training on outcomes of exercise tolerance or strength in adults. Nine studies were identified, with six included in the meta-analysis. No significant difference in rate of perceived exertion was found (SMD-0.06, 95% CI-0.41 to 0.29, p =0.73, I 2 =80%). Subgroup analysis excluding studies that introduced bias showed a shift towards favoring the use of intermittent blood flow restriction training (SMD-0.42, 95% CI-0.87 to 0.03, p =0.07, I 2 =0%). There was no significant difference in strength gain. Intermittent cuff deflations during training intervals does not improve tolerance to exercise during blood flow restriction training. [ABSTRACT FROM AUTHOR]

Background: Upper limb arthroplasty is an increasingly used treatment modality for end-stage joint disease of the shoulder, elbow and wrist. Whilst complications have been reported, the risk of venous thromboembolism has received less attention when compared to the lower limb. Guidance to aid clinical decision-making remains limited. This review aims to ascertain whether venous thromboembolism prophylaxis is beneficial after upper limb major joint replacement surgery. Methods: A systematic review was performed in April 2019, utilising EMBASE, MEDLINE, Cochrane and Google Scholar. All clinical studies reporting venous thromboembolism incidence and risk reduction (after prophylaxis) in upper limb joint replacement were included. Results: Twenty-four observational studies were identified. The reported incidence of venous thromboembolism ranged from 0.2% to 16% (weighted mean 0.68%) and 0.2% to 0.8% (weighted mean 0.49%) in shoulder and elbow arthroplasty, respectively. No records for wrist arthroplasty were found. In the literature, baseline venous thromboembolism risk of patients without an operation is reported as 0.5%. Discussion: There is a lack of good quality evidence regarding the risks and benefits of venous thromboembolism prophylaxis in upper limb major joint replacement surgery. We recommend further research, ideally formal randomised controlled trials to guide recommendations. Although venous thromboembolism is rare in upper limb surgery, surgeons should remain vigilant to this possibility. [ABSTRACT FROM AUTHOR]

High levels of stress, burnout, and symptoms of poor mental health have been well known among practicing doctors for a number of years. Indeed, many health systems have formal and informal mechanisms to offer support and treatment where needed, though this varies tremendously across cultures. There is increasing evidence that current medical students, our doctors of the future, also report very high levels of distress, burnout, and substance misuse. We sampled large groups of medical students in 12 countries at the same time and with exactly the same method in order to aid direct comparison. 3766 students responded to our survey across five continents in what we believe is a global first. Our results show that students in all 12 countries report very high levels of 'caseness' on validated measures of psychiatric symptoms and burnout. Rates of substance misuse, often a cause of or coping mechanism for this distress, and identified sources of stress also varied across cultures. Variations are strongly influenced by cultural factors. Further quantitative and qualitative research is required to confirm our results and further delineate the causes for high rates of psychiatric symptoms and burnout. Studies should also focus on the implementation of strategies to safeguard and identify those most at risk. [ABSTRACT FROM AUTHOR]